Nikhil Shah, MD, FACC, FHRS
@shah.md
Cardiac Electrophysiologist at Reliant Medical Group and Cardiology Fellowship Associate Program Director
Husband, dog dad, musician, technology enthusiast
#EPeeps #CardioSky #MedSky
(Thoughts + posts are my own)
Husband, dog dad, musician, technology enthusiast
#EPeeps #CardioSky #MedSky
(Thoughts + posts are my own)
Was literally talking to my fellow about this on Friday. I've always preferred the anchor method for this theoretical risk... But apparently it's not so theoretical anymore!
#EPeeps #CSP #CardioSky
@jice-ep.bsky.social rdcu.be/emm0I
#EPeeps #CSP #CardioSky
@jice-ep.bsky.social rdcu.be/emm0I
May 18, 2025 at 12:56 PM
Was literally talking to my fellow about this on Friday. I've always preferred the anchor method for this theoretical risk... But apparently it's not so theoretical anymore!
#EPeeps #CSP #CardioSky
@jice-ep.bsky.social rdcu.be/emm0I
#EPeeps #CSP #CardioSky
@jice-ep.bsky.social rdcu.be/emm0I
MR severity should NOT be a reason to avoid AF ablation (recurrence similar mild vs mod/severe MR, ~43% in both)
MR often ⬇️ s/p ablation (89% ⬇️ ≥1 grade of severity, OR 0.93)
#HRS2025 #EPeeps
www.jacc.org/doi/10.1016/... @jaccjournals.bsky.social
MR often ⬇️ s/p ablation (89% ⬇️ ≥1 grade of severity, OR 0.93)
#HRS2025 #EPeeps
www.jacc.org/doi/10.1016/... @jaccjournals.bsky.social
April 27, 2025 at 7:12 PM
MR severity should NOT be a reason to avoid AF ablation (recurrence similar mild vs mod/severe MR, ~43% in both)
MR often ⬇️ s/p ablation (89% ⬇️ ≥1 grade of severity, OR 0.93)
#HRS2025 #EPeeps
www.jacc.org/doi/10.1016/... @jaccjournals.bsky.social
MR often ⬇️ s/p ablation (89% ⬇️ ≥1 grade of severity, OR 0.93)
#HRS2025 #EPeeps
www.jacc.org/doi/10.1016/... @jaccjournals.bsky.social
Live music, free beer and taquitos at the epicenter! What could be better? #HRS2025 #dysrhythmics #EPeeps
April 25, 2025 at 12:36 AM
Live music, free beer and taquitos at the epicenter! What could be better? #HRS2025 #dysrhythmics #EPeeps
The data shows it's time to think 2️⃣x before #PFA on the CTI. Severe spasm may occur w/o ECG changes. There is also on average a 10% ⬇️ in vascular luminal area at 3 mo repeat cor angio but long term symptoms/impact remains unknown. 1 mg NTG can ⬇️ spasm severity
#HRS2025 #EPeeps
#HRS2025 #EPeeps
April 25, 2025 at 12:31 AM
Fascinating study: in HCM patients, PFA is associated with better outcomes than thermal ablation. Thermal + non-PV ablation is FAR inferior to PFA + non-PV ablation. Small study but thought provoking! #EPeeps #CardioSky
www.jacc.org/doi/10.1016/...
www.jacc.org/doi/10.1016/...
March 15, 2025 at 12:45 PM
Fascinating study: in HCM patients, PFA is associated with better outcomes than thermal ablation. Thermal + non-PV ablation is FAR inferior to PFA + non-PV ablation. Small study but thought provoking! #EPeeps #CardioSky
www.jacc.org/doi/10.1016/...
www.jacc.org/doi/10.1016/...
Great data presented in this study of >23k patients with AF from 2007-2021 regarding AAD use after ablation (46% after 1st), redos after index ablation (16%), RR of repeat ablation with various risk fx's (lsps AF vs pAF 2.26, AAD use 1.42, etc). Worth a read for #EPeeps
www.jacc.org/doi/10.1016/...
www.jacc.org/doi/10.1016/...
February 15, 2025 at 1:14 PM
Great data presented in this study of >23k patients with AF from 2007-2021 regarding AAD use after ablation (46% after 1st), redos after index ablation (16%), RR of repeat ablation with various risk fx's (lsps AF vs pAF 2.26, AAD use 1.42, etc). Worth a read for #EPeeps
www.jacc.org/doi/10.1016/...
www.jacc.org/doi/10.1016/...
I ablated initially further distal and inferior and crept up (older patient with CMPY unable to take meds upon returning home to their country) and ultimately found the perfect spot as noted in the prior post inferior to the tag in the prior map. No non-conducted beats seen during any ablation.
December 20, 2024 at 3:54 PM
I ablated initially further distal and inferior and crept up (older patient with CMPY unable to take meds upon returning home to their country) and ultimately found the perfect spot as noted in the prior post inferior to the tag in the prior map. No non-conducted beats seen during any ablation.
Everyone who had suggested a para hisian origin is correct! Going into the case, I suspected it would be superior to the his but far enough away given the notching seen in the QRS. It turned out to be ~4-5 mm distal to the His and slightly inferior to the RBB (slightly below the blue tag)
December 20, 2024 at 11:39 AM
Everyone who had suggested a para hisian origin is correct! Going into the case, I suspected it would be superior to the his but far enough away given the notching seen in the QRS. It turned out to be ~4-5 mm distal to the His and slightly inferior to the RBB (slightly below the blue tag)
Here is all 12 leads of the PVC.
@stevenzurita.bsky.social @krishmd.bsky.social @epsri.bsky.social @amrish.bsky.social @allenamornmd.bsky.social @docabhinavheart.bsky.social @johnkeaney.bsky.social @dredcronin.bsky.social @pcwep.bsky.social @cardiacpa1.bsky.social @epeepsbot.bsky.social
@stevenzurita.bsky.social @krishmd.bsky.social @epsri.bsky.social @amrish.bsky.social @allenamornmd.bsky.social @docabhinavheart.bsky.social @johnkeaney.bsky.social @dredcronin.bsky.social @pcwep.bsky.social @cardiacpa1.bsky.social @epeepsbot.bsky.social
December 19, 2024 at 3:01 AM
Not too much activity from #EPeeps on here recently. Let's try to change that and play everyone's favorite game: guess the SoO!
@narrowqrs.bsky.social @jeffreyvinocur.bsky.social @ktamirisamd.bsky.social @jkhmd.bsky.social @willyhfrick.bsky.social @williskwandou.bsky.social
@narrowqrs.bsky.social @jeffreyvinocur.bsky.social @ktamirisamd.bsky.social @jkhmd.bsky.social @willyhfrick.bsky.social @williskwandou.bsky.social
December 19, 2024 at 3:01 AM
Not too much activity from #EPeeps on here recently. Let's try to change that and play everyone's favorite game: guess the SoO!
@narrowqrs.bsky.social @jeffreyvinocur.bsky.social @ktamirisamd.bsky.social @jkhmd.bsky.social @willyhfrick.bsky.social @williskwandou.bsky.social
@narrowqrs.bsky.social @jeffreyvinocur.bsky.social @ktamirisamd.bsky.social @jkhmd.bsky.social @willyhfrick.bsky.social @williskwandou.bsky.social
Post a picture you took to add some calm to the timeline.
Iceland is a beautiful country (despite the absolutely freaking cold weather)!
Iceland is a beautiful country (despite the absolutely freaking cold weather)!
November 29, 2024 at 9:48 PM
Post a picture you took to add some calm to the timeline.
Iceland is a beautiful country (despite the absolutely freaking cold weather)!
Iceland is a beautiful country (despite the absolutely freaking cold weather)!
Awesome thank you! This area is very interesting
November 23, 2024 at 10:04 PM
Awesome thank you! This area is very interesting
This patient in their 80s with a BiV ICD was started on an antiarrhythmic drug 1 week prior to this ECG. Any guesses as to which drug? #CardioSky #MedSky #EPeeps
November 21, 2024 at 5:48 AM
This patient in their 80s with a BiV ICD was started on an antiarrhythmic drug 1 week prior to this ECG. Any guesses as to which drug? #CardioSky #MedSky #EPeeps
In the right patients (young, few comorbidities, rapid AF, slow resting heart rates, small left atrium) --> early catheter ablation may be the right 1st step in rhythm control.
A topic for another time, but also deserves mention: appropriate patients with HFrEF and a fib benefit from ablation too!
A topic for another time, but also deserves mention: appropriate patients with HFrEF and a fib benefit from ablation too!
November 20, 2024 at 4:45 AM
In the right patients (young, few comorbidities, rapid AF, slow resting heart rates, small left atrium) --> early catheter ablation may be the right 1st step in rhythm control.
A topic for another time, but also deserves mention: appropriate patients with HFrEF and a fib benefit from ablation too!
A topic for another time, but also deserves mention: appropriate patients with HFrEF and a fib benefit from ablation too!
The newest 2023 AF guidelines (ACC/AHA/HRS) CLASS I indication for ablation for patients like this. The 2024 ESC guidelines also have similar language for young patients with few comorbidities and symptomatic AF.
3/3
3/3
November 20, 2024 at 4:36 AM
The newest 2023 AF guidelines (ACC/AHA/HRS) CLASS I indication for ablation for patients like this. The 2024 ESC guidelines also have similar language for young patients with few comorbidities and symptomatic AF.
3/3
3/3
Interesting study with some unique findings. Summary is from the linked news story, central figure from the actual article (www.jacc.org/doi/full/10....)
November 17, 2024 at 12:46 AM
Interesting study with some unique findings. Summary is from the linked news story, central figure from the actual article (www.jacc.org/doi/full/10....)
Clinically relevant non-major bleeding is what most of my patients asking about watchman have had. Here there is a much larger difference with a HR of 0.5. To me this is a group where there may be benefit (ie the less sick patients) 3/3
November 16, 2024 at 9:13 PM
Clinically relevant non-major bleeding is what most of my patients asking about watchman have had. Here there is a much larger difference with a HR of 0.5. To me this is a group where there may be benefit (ie the less sick patients) 3/3
Hello #DogSky #DogsofBluesky my name is Biscuit and I love to sit in the warm 🌞
November 16, 2024 at 6:52 PM
Hello #DogSky #DogsofBluesky my name is Biscuit and I love to sit in the warm 🌞
Great figure! Had not seen this one before. Here is the photo in high-res #CardioSky
November 16, 2024 at 6:09 PM
Great figure! Had not seen this one before. Here is the photo in high-res #CardioSky
Beyond the diagnosis, there are at least two or three other interesting findings on this ECG. What do you think?
#ECGoftheweek #MedSky #CardioSky #EPeeps
#ECGoftheweek #MedSky #CardioSky #EPeeps
November 14, 2024 at 10:57 PM
Beyond the diagnosis, there are at least two or three other interesting findings on this ECG. What do you think?
#ECGoftheweek #MedSky #CardioSky #EPeeps
#ECGoftheweek #MedSky #CardioSky #EPeeps
Happy Sunday from Biscuit and lamb chop!
November 10, 2024 at 7:17 PM
Happy Sunday from Biscuit and lamb chop!
One of the wildest zio tracings I've seen from a few years ago. Over 80 seconds of CHB/asystole. The patient received a pacemaker within 24 hours of the event. #EPeeps #CardioSky
November 10, 2024 at 4:54 PM
One of the wildest zio tracings I've seen from a few years ago. Over 80 seconds of CHB/asystole. The patient received a pacemaker within 24 hours of the event. #EPeeps #CardioSky